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What’s next for health care reform?

After court ruling, focus turns to state plans for Medicaid

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Now that the Supreme Court has upheld the constitutionality of President Obama’s health care reform law, advocates are pushing for additional efforts to extend coverage of the law to LGBT people and people with HIV/AIDS to the fullest extent possible.

For the most part, the next step in the process involves looking to the states to determine whether they will adopt health policies afforded to them under the law — foremost among them is the Medicaid expansion to cover all people with incomes up to 133 percent of the federal poverty level.

Although the Supreme Court ruled the majority of the health care law is constitutional, it prevented the federal government from withholding all Medicaid funds from states if they decline to take part in the Medicaid expansion. As a result, states can decide whether or not to enter the expansion without fear of losing money.

Patrick Paschall, a policy advocate at the National Gay & Lesbian Task Force, said the Medicaid expansion is particularly important for LGBT people because they disproportionately live below the poverty level.

“The Medicaid expansions are going to end up being hugely important for LGBT people because it expands coverage to low-income people, and LGBT people are disproportionately low-income,” Paschall said. “We know this because of rampant employment discrimination and housing discrimination.”

A report on transgender people published earlier this year by the Task Force and the National Center for Transgender Equality, titled “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” found that transgender people experience unemployment at rates twice that of the national population, and black transgender people experience it at a rate of four times as much.

Carl Schmid, deputy executive director of the AIDS Institute, said the Medicaid expansion is particularly important for people with HIV/AIDS because of 50 percent of those in care rely on that program for support and those numbers will “grow substantially” if states decide to participate.

“Those who are really poor, they’re going to be covered under Medicaid,” Schmid said. “The question is what are we expecting from the states.”

But a number of states may not take part. According to a report in The Hill newspaper, at least 15 governors have signaled they won’t participate in the Medicaid expansion now that the Supreme Court has enabled them to wiggle out of participation.

Florida Gov. Rick Scott, a Republican elected to office during the Tea Party wave in 2010, was among those saying his state wouldn’t take part in the Medicaid expansion — or other parts of the health care law that are optional to the states.

“We’re not going to implement Obamacare in Florida,” Scott said last week on Fox News. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”

Under the health care reform law, the federal government will pay for the Medicaid expansion for the first few years. Expenses for states come up in 2017, when the federal government will pay 95 percent; That’s reduced to 94 percent in 2018 and in 2019 it goes down to 93 percent. Starting in 2010 and then on out, the federal government will pay 90 percent of the total amount.

Schmid said the bargain that was set up for states under the health care law makes the governors’ decision not to participate in the law questionable.

“Here their taxpayers are going to be paying their taxes to pay for this; this is federal funds,” Schmid said. “Their state is not going to take responsibility for covering. The hospitals? Don’t they want people to be covered? They’re going to have unconstituted care if they don’t.”

For the states that don’t participate in the Medicaid expansion, Schmid said people living there with HIV/AIDS will have to continue relying on the Ryan White Care Program, which provides funds for AIDS medications for low-income people with HIV. The program will be up for reauthorization in 2013.

As advocates push for states to adopt the Medicaid expansion, the law has several key components that already offer protections and benefits for LGBT people and people with HIV/AIDS. State and federal health insurance will be set up in the law starting in 2014.

For the first time, the law extends federal non-discrimination protection in the health care system on the basis of gender.

Paschall noted that provision is key as courts and agencies have determined that discrimination against transgender people amounts to gender discrimination.

“We know that federal agencies like the Equal Employment Opportunity Commission, the Department of Housing & Urban Development as well as federal courts have interpreted sex-based discrimination to include protections on the basis of gender identity and sex stereotypes,” Paschall said. “What this means is that in the context of health care, LGBT people, especially transgender people have now for the first time protections in that setting, which is hugely important.”

Earlier this year, the Department of Health & Human Services issued rules saying that no program activity in an exchange, nor a health plan, can discriminate on the basis of sexual orientation and gender identity. The rule takes effect when exchanges open in 2014.

The administration has taken additional efforts to help the LGBT community when it comes to accessing health care. Same-sex couples can now search for health plans that cover domestic partners through the health care finder tool at healthfinder.gov. HHS has also undertaken data collection efforts to include questions about sexual orientation and gender identity in surveys like the National Health Interview Survey.

Still, advocates are looking for additional efforts from the administration — in addition to the adoption of the Medicaid expansion by the states — to ensure LGBT people are included in health care reform to the greatest extent possible.

Paschall said the Task Force wants to see data collection efforts expanded beyond the federal surveys already designated by the administration.

“Generally speaking, we would like to see sexual orientation and gender identity questions added to all federal surveys where demographic data is collected,” he said. “Our priorities include a number of federal surveys, maybe most notably the American Community Survey, which is an annual survey that collects demographic data and is considered one of the largest annual data sources on the American population.”

Paschall continued, “We’re also working with them to ensure that those questions are developed and included in other federal health surveys across the board so that we can have more data in more areas identify where those disparities are.”

For people living with HIV/AIDS, Schmid said he is awaiting from the administration regulatory guidance in the next couple months on essential health benefits to cover people in the Medicaid program and federal exchanges.

“We’ll see if the coverage will be strong enough for medications and for all different other services,” Schmid said.

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Federal Government

UPenn erases Lia Thomas’s records as part of settlement with White House

University agreed to ban trans women from women’s sports teams

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U.S. Education Secretary Linda McMahon (Screen capture: C-SPAN)

In a settlement with the Trump-Vance administration announced on Tuesday, the University of Pennsylvania will ban transgender athletes from competing and erase swimming records set by transgender former student Lia Thomas.

The U.S. Department of Education’s Office for Civil Rights found the university in violation of Title IX, the federal rights law barring sex based discrimination in educational institutions, by “permitting males to compete in women’s intercollegiate athletics and to occupy women-only intimate facilities.”

The statement issued by University of Pennsylvania President J. Larry Jameson highlighted how the law’s interpretation was changed substantially under President Donald Trump’s second term.

“The Department of Education OCR investigated the participation of one transgender athlete on the women’s swimming team three years ago, during the 2021-2022 swim season,” he wrote. “At that time, Penn was in compliance with NCAA eligibility rules and Title IX as then interpreted.”

Jameson continued, “Penn has always followed — and continues to follow — Title IX and the applicable policy of the NCAA regarding transgender athletes. NCAA eligibility rules changed in February 2025 with Executive Orders 14168 and 14201 and Penn will continue to adhere to these new rules.”

Writing that “we acknowledge that some student-athletes were disadvantaged by these rules” in place while Thomas was allowed to compete, the university president added, “We recognize this and will apologize to those who experienced a competitive disadvantage or experienced anxiety because of the policies in effect at the time.”

“Today’s resolution agreement with UPenn is yet another example of the Trump effect in action,” Education Secretary Linda McMahon said in a statement. “Thanks to the leadership of President Trump, UPenn has agreed both to apologize for its past Title IX violations and to ensure that women’s sports are protected at the university for future generations of female athletes.”

Under former President Joe Biden, the department’s Office of Civil Rights sought to protect against anti-LGBTQ discrimination in education, bringing investigations and enforcement actions in cases where school officials might, for example, require trans students to use restrooms and facilities consistent with their birth sex or fail to respond to peer harassment over their gender identity.

Much of the legal reasoning behind the Biden-Harris administration’s positions extended from the 2020 U.S. Supreme Court case Bostock v. Clayton County, which found that sex-based discrimination includes that which is based on sexual orientation or gender identity under Title VII rules covering employment practices.

The Trump-Vance administration last week put the state of California on notice that its trans athlete policies were, or once were, in violation of Title IX, which comes amid the ongoing battle with Maine over the same issue.

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New York

Two teens shot steps from Stonewall Inn after NYC Pride parade

One of the victims remains in critical condition

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The Stonewall National Memorial in New York on June 19, 2024. (Washington Blade photo by Michael K. Lavers)

On Sunday night, following the annual NYC Pride March, two girls were shot in Sheridan Square, feet away from the historic Stonewall Inn.

According to an NYPD report, the two girls, aged 16 and 17, were shot around 10:15 p.m. as Pride festivities began to wind down. The 16-year-old was struck in the head and, according to police sources, is said to be in critical condition, while the 17-year-old was said to be in stable condition.

The Washington Blade confirmed with the NYPD the details from the police reports and learned no arrests had been made as of noon Monday.

The shooting took place in the Greenwich Village neighborhood of Manhattan, mere feet away from the most famous gay bar in the city — if not the world — the Stonewall Inn. Earlier that day, hundreds of thousands of people marched down Christopher Street to celebrate 55 years of LGBTQ people standing up for their rights.

In June 1969, after police raided the Stonewall Inn, members of the LGBTQ community pushed back, sparking what became known as the Stonewall riots. Over the course of two days, LGBTQ New Yorkers protested the discriminatory policing of queer spaces across the city and mobilized to speak out — and throw bottles if need be — at officers attempting to suppress their existence.

The following year, LGBTQ people returned to the Stonewall Inn and marched through the same streets where queer New Yorkers had been arrested, marking the first “Gay Pride March” in history and declaring that LGBTQ people were not going anywhere.

New York State Assemblywoman Deborah Glick, whose district includes Greenwich Village, took to social media to comment on the shooting.

“After decades of peaceful Pride celebrations — this year gun fire and two people shot near the Stonewall Inn is a reminder that gun violence is everywhere,” the lesbian lawmaker said on X. “Guns are a problem despite the NRA BS.”

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New York

Zohran Mamdani participates in NYC Pride parade

Mayoral candidate has detailed LGBTQ rights platform

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NYC mayoral candidate and New York State Assembly member Zohran Mamdani (Screen capture: NBC News/YouTube)

Zohran Mamdani, the candidate for mayor of New York City who pulled a surprise victory in the primary contest last week, walked in the city’s Pride parade on Sunday.

The Democratic Socialist and New York State Assembly member published photos on social media with New York Attorney General Letitia James, telling followers it was “a joy to march in NYC Pride with the people’s champ” and to “see so many friends on this gorgeous day.”

“Happy Pride NYC,” he wrote, adding a rainbow emoji.

Mamdani’s platform includes a detailed plan for LGBTQ people who “across the United States are facing an increasingly hostile political environment.”

His campaign website explains: “New York City must be a refuge for LGBTQIA+ people, but private institutions in our own city have already started capitulating to Trump’s assault on trans rights.

“Meanwhile, the cost of living crisis confronting working class people across the city hits the LGBTQIA+ community particularly hard, with higher rates of unemployment and homelessness than the rest of the city.”

“The Mamdani administration will protect LGBTQIA+ New Yorkers by expanding and protecting gender-affirming care citywide, making NYC an LGBTQIA+ sanctuary city, and creating the Office of LGBTQIA+ Affairs.”

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